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Full text of "United States Navy Medical News Letter Vol. 34 No. 4, 21 August 1959"

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UNITED STATES NAVY 

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Rear Admiral Bartholomew W. Hogan MC USN - Surgeon General 
Captain Donald R. Childs MC USN - Editor 



Vol. 34 



Friday, 2 1 August 1959 



No. 4 



1842 



Bureau of Medicine and Surgery 
117th Anniversary 



1959 



MESSAGE FROM THE SURGEON GENERAL 



To All Officers and Men of the Medical Department: 

On the occasion of another anniversary, it is appropriate to reflect 
on the progress of the Navy Medical Department. As indicated in the his- 
torical sketch that follows in this issue of the Medical News Letter, the 
accomplishments have been manifold and continuous. The future promises 
even more achievements — some more spectacular — as medical problems 
of atomic submarine and space travel are resolved. 

Yet, recognizing the need for, and beneficial results of, such 
research and development in new areas of medicine, the principal purpose 
of the Medical Department continues to be the day to day maintenance of a 
high level of professional care and personal relationship which is contributed 
to by each individual officer and man of the various Corps of the Department. 
I take personal satisfaction in the contribution each individual has made, often 
in the face of shortages of funds and personnel, and extend congratulations to 
all — Regular and Reserve, active and inactive. The maintenance of, and 
improvement on, the enviable record of the past is a challenge to us all. 



Medical News Letter, Vol. 34, No. 4 



TABLE OF CONTENTS 

Message from the Surgeon General 1 

History of the Medical Department 3 

Choice and Use of New Drugs 6 

Prevention of Rabies in Man 9 

Survival in Acute Leukemia 10 

Treatment of Hypercholesterolemia 11 

Occlusive Disease of the Carotid Arteries 12 

Prognosis for Rehabilitation in Strokes 13 

Physiology of Dumping Syndrome 15 

Stimulation of Bone Growth • 17 

BuMed Receives Film Festival Certificate 18 

Words of Approbation 19 

Medical Defense Against Chemical Warfare - Film Release 20 

New Look in Ophthalmic Frames 21 

Postgraduate Short Courses at Armed Forces Institute of Pathology 22 

Board Certifications 22 

IN MEMORIAM 23 

Recent Research Reports ■ 23 

From the Note Book. .' 25 

Influenza Vaccination Program {BuMed Notice 6230) 28 

DENTAL SECTION 

Management of Gagging Patients 29 

More About Fluoridation 29 

Personnel News 30 

Dental Service Report (DD 477) - - 30 

RESERVE' SECTION 

Armed Services Orthopedic Seminar 31 

Meeting of American Psychological Association 31 

Revision of Promotion Policy 31 

New Identification Cards for Inactive Reservists 32 

AVIATION MEDICINE SECTION 

Indoctrination and Fleet Evaluation of Navy's Full Pressure Suit 33 

Cardiac Arrest (Bibliography) 37 

Reserve Seminar in Aviation Medicine 38 

The Navy Doctor 38 

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Medical News Letter, Vol. 34, No. 4 



History of the Medical Department 

The story of the Medical Department of the United States Navy is one 
to arouse pride and stimulate enthusiasm in every American citizen Con- 
tinuous strides — at times stupendous — have been taken in the quality of med- 
ical care provided for personnel of the Navy and Marine Corps. 

It is well to note and give thought to the advances that have been made 
beyond the conditions of ignorance and neglect prevalent in the eighteenth 
century. Then, disease and pestilence being rampant, a severely wounded 
sailor had little hope of survival. Now, the morbidity rate in the Navy has 
been reduced to the lowest point in history, and during the Korean Conflict the 
mortality rate of 2% for the Navy and Marine Corps personnel wounded in com- 
bat was an all time low. 

The practice of naval medicine in America had its beginnings late in 
1775 when the first American fleet was placed in commission by Acts of the 
Continental Congress. Physicians originally were selected by commanders of 
naval vessels to serve on individual voyages, and often were assisted only by 
the oldest or most incompetent of the seamen on board. Much of the financial 
reward the surgeon could expect consisted of a share in such booty as the ship 
might capture. 

In 1798, when the Navy Department was established, surgeons and 
surgeon's mates were given the status of commissioned officers. For the 
next 44 years there was no medical department, only individual officers, not 
organized in any sense, participating in a gradual evolution toward adequate 
medical support of the Navy. A Marine Hospital Fund, established by monthly 
payments from all seamen, subsequently augmented by money from fines and 
forfeitures, financed hospitals, most of which were in unsatisfactory buildings 
selected without plan. A major accomplishment of the Fund was the arrange- 
ment for building the first permanent hospital. This was located at Norfolk, Va. , 
where the first patients were received in 1830. Other hospitals, financed by 
regular appropriations, soon followed — Philadelphia in 1833, Boston in 1836, 
and Brooklyn in 1838. 

Throughout the early portion of the nineteenth century a number of 
able and energetic physicians fought for a well organized and adequately 
equipped medical department. Their efforts resulted in improvement in qual- 
ity of professional personnel, medical equipment and supplies, and quarters 
for the sick on board ships and at hospitals ashore. 

William P. C, Barton, outstanding among this group, was responsible 
for establishing a medical journal on each patient and a medical library in each 
naval medical unit. His proposal for utilizing female nurses in hospitals went 
unheeded for two generations. Perhaps his greatest contribution was the 
writing of "A Plan for the Internal Organization and Government of Marine 
(Navy) Hospitals. This treatise and his continuous efforts had much to do with 
the establishment in 1842 of the Bureau of Medicine and Surgery which was 
created to supervise naval medical affairs along the lines he had proposed. 



Medical News Latter, Vol. 34, No, 4 



Most appropriately, he was named the first Chief of the Bureau. The title, 
Surgeon General — not created until 1871 — was first held by William M. Wood, 
the fifth Chief of the Bureau. 

From its inception, the new Bureau made notable progress in organ- 
izing, developing, and perfecting naval medicine. Fascinating accounts of 
many aspects of this progress can be found in the reports to the Secretary of 
the Navy made each year since Civil War times by the Chief of the Bureau or, 
after 1871, by the Surgeon General. This unbroken series has been of great 
value to students of preventive medicine, vital statisticians, and public health 
authorities, in determining trends of morbidity and mortality rates. 

One early development — the establishment of hospitals in ships — con- 
ferred mobility on definitive medical and surgical care. The best known hos- 
pital ship employed during the Civil War, RED ROVER, was a Mississippi 
sidewheeler captured from Confederate forces and' converted for use as a 
hospital under the command of Surgeon Ninian Pinkney. The staff included the 
first female nurses of record in the Navy. They were Nursing Sisters who vol- 
unteered only for service during the war. 

Other hospital ships followed. Of these, the USS SOLACE, converted 
to hospital use in 1898 during the Spanish-American War, was the first of our 
naval vessels to fly the Geneva Red Cross flag. A long controversy over whether 
a medical or line officer should command such a ship ended in placing a line 
officer in command of the ship proper, with a medical officer in command of the 
hospital within the ship and all professional medical matters. 

During World War I and World War II, more and more advanced hospital 
ships were developed. Near the close of the latter war, some 12 hospital ships 
were in operation by the Navy. Still greater effectiveness was achieved during 
the Korean Conflict by the addition of landing platforms for helicopters so that 
casualties could be flown in a matter of minutes from close behind the front 
line to the safety and expert care available on the ship. Such atraumatic and 
expeditious handling saved many lives. 

Other early developments of great value were instituted by the Bureau 
of Medicine and Surgery. A book, Instruction for Medical Officers, now known 
as the Manual of the Medical Department, was first published in 1886. A Naval 
Medical School, for postgraduate instruction in special aspects of naval medicine, 
was established by Surgeon General Presley M. Rixey in 1902 for indoctrination 
of newly appointed Medical officers. Annual physical examinations of naval 
personnel were begun in 1909. To provide current professional reports to 
Medical Department personnel, publication of the U.S. Naval Medical Bulletin 
was inaugurated in 1907. The Bulletin, with its successor, the U.S. Armed 
Forces Medical Journal, has been published continuously to the present day. 
A supplementary Hospital Corps Quarterly — now the Medical Technicians 
Bulletin — was providedfornonprofessional Medical Department personnel. 

The term, Medical Corps, was first employed in an appropriation act of 
1871. Thereafter, Medical officers were listed as members of the Staff Corps 






Medical News Letter, Vol. 34, No. 4 



of the Navy. Their grades were Medical Director, Medical Inspector, Surgeon, 
Passed Assistant Surgeon, and Assistant Surgeon with the respective ranks of 
Captain, Commander, Lieutenant Commander, Lieutenant, and Master (later 
changed to Lieutenant, junior grade). Since 1918, Medical officers have held 
the regular military titles of their rank. 

Prior to 1898, enlisted assistants to Medical officers were known suc- 
cessively as loblolly boys, surgeon's stewards, apothecaries, nurses, and 
baymen. In that year, the Hospital Corps was established by legislation which 
specified qualifications and duties. The 61 years that have elapsed since then 
have seen the Hospital Corps demonstrate increasingly high morale and tech- 
nical competence based on fine quality of personnel assigned to the Corps and 
careful training afforded each member. 

The Navy Nurse Corps was established without commissioned rank in 
1908. Female nurses then began to serve ably in many shore-based hospitals 
and on hospital ships. In World War II, over 11, 000 nurses were in service. 
An Act of 1947 made members of the Nurse Corps permanently commissioned 
staff officers with rank, pay, and allowances equal to those of other staff offi- 
cers up to, and including, Captain. Officers of the Nurse Corps have per- 
formed invaluable service in field medical units in Japan and Korea, in troop 
air transports, on hospital and sea transport ships, and in all shore-based 
hospitals. 

The Dental Corps, established in 1912, has provided Dental officers 
who have served with distinction in both world wars and in Korea. Over 7, 000 
were in service during World War II. In 1945, an organization change in the 
Bureau of Medicine and Surgery assigned to Dental officers the technical con- 
trol of dental activities ashore and afloat. 

The Medical Service Corps was established in 1947, giving commis- 
sioned rank to administrative specialists and men trained in such fields as 
pharmacy, optometry, psychology, bacteriology, and other sciences related 
to medicine. Officers of the Medical Service Corps, with ranks up to, and 
including, Captain have been of immeasurable assistance to Medical and Dental 
officers by absorbing much of the administrative work load and serving as 
specialists in various sciences. 

During the present century, training and technical education have ex- 
panded continuously in step with growing specialization, increasing complexity 
of the medical sciences, and enlarging scope of Medical Department operation. 
In 1902, in addition to the Naval Medical School, there was established at 
Norfolk, Va. , the first school for training hospital corpsmen. In 1922, tb.c- 
Naval Dental School was inaugurated for postgraduate training of Dental officers. 
In 1939, the Naval School of Aviation Medicine was set up at Pensacola, Fla. ; 
in 1942, the Naval School of Hospital Administration was opened at Bethesda, 
Md. ; and in 1951, Field Medical Service Schools were commissioned at Camp 
Pendleton and Camp Lejeune. 

The Bureau of Medicine and Surgery, observing its 117th anniversary 
on 3 1 August 1959, is the only Navy Bureau retaining its origin;*! name as 



Medical News Letter, Vol. 34, No. 4 



established by Congress in 1842. However, only since 1942 has it occupied 
the present quarters in a group of buildings which includes the old Naval Obser- 
vatory. The more recent accomplishments of the Medical Department of the 
United States Navy and those of the devoted officers and men who constitute it 
have been so many and varied that they cannot be mentioned in this short his- 
torical sketch. Suffice it to say that naval medicine has made tremendous 
progress since 1775 and in recent years has been enormously accelerated. 
Today, the quality of professional care furnished to Navy and Marine Corps 
personnel is outstanding and second to none. (Adapted from historical sketch 
in Anniversary Book, U. S. Naval Hospital and U. S. Naval Hospital Corps 
School, San Diego, Calif., 1919-1958) 

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Choice and Use of New Drugs 

"Due to the extremely fertile mating of the synthetic chemist and the 
pharmaceutical manufacturer, drugs appear on the market almost too quickly 
for one to learn the names, to say nothing of distinguishing which are the same 
drugs with different proprietary names. " This constitutes a serious problem 
when it is realized that some 550 new preparations a year, or more than one a 
day, are introduced to practicing physicians. The results of lack of informa- 
tion relative to these preparations are evident when it is seen that 5% of 1, 000 
consecutive admissions to a major hospital in New York City are because of 
undesirable effects of some of these new agents. Ignorance of uses, limitations, 
and dangers are the major handicap to the physician faced with such a vast arma- 
mentarium. Certainly, the patient resents being used in any trial-and-error 
process. Therefore, the background work of any new drug is critical informa- 
tion. 

The responsibility of chemist and drug manufacturer lies in careful 
study of the pharmacologic and physiologic properties of the new chemical in 
the laboratory animal, with accurate and complete translation to similar pro- 
cesses in the human being. Premature publicity in the lay press may result in 
undue pressure for clinical application before all facets of the effects of a new 
chemical are understood. This may result in unjustified condemnation of a 
valuable preparation because of poor results stemming from inaccurate trans- 
ference to clinical conditions. 

The genius of the synthetic chemist results in a visualization of slight 
alterations of chemical structures and remarkably accurate anticipation of 
physiologic results. These alterations must be accurately tested as their effects 
are not necessarily as anticipated, and changes do not necessarily mean im- 
provement. Months to years often are needed for accurate clinical appraisal. 

The patterns of drug action determine whether a new chemical is of 
clinical applicability. Potency is an obvious primary factor. However, the 
listed potency of a drug may be misleading and/or inaccurate, for potency in 



Medical News Letter, Vol. 34, No, 4 



itself is not as important as therapeutic ratio. It does not necessarily follow 
that a drug producing therapeutic effects with a comparatively smaller quan- 
tity than another is more safe, nor is. the converse true. Relative potency — 
a greater ceiling of action — determines greater desirability and applicability. 

Of the untoward reactions of drugs, toxic ones are usually those cap- 
able of being anticipated, and are related to the size or duration of the dose, 
and exhibit an intermediary range in which some reactions may occur but are 
not serious. Individual response may alter the expected width of therapeutic 
range and mandates careful individual evaluation as therapy progresses. The 
minor side effects of some drugs are valuable clues to impending toxicity, while 
others exhibit no such warning signs and present more dangers. Allergic reac- 
tions are individual patient responses, are usually unpredictable, and may be 
disastrous. Some drugs and some patients exhibit this tendency. "A tainted 
heredity in drug as well as patient should never be ignored. " 

The curve of action of a drug is another essential pattern of drug action 
which determines the dose, frequency of dose, and site of administration. The 
rate and extent of absorption rigidly determine usefulness and total dose in a 
given situation. The features of absorption from varying sites or methods of 
application, in addition to full knowledge of possible intermediary processes 
between absorption and utilization, are of practical importance. Alteration, 
neutralization, or elimination also constitute features of the curve of action 
that must be taken into consideration. 

'The amount of a drug which will produce a pharmacodynamic effect has 
special significance in relation to the amount of the same drug which will pro- 
duce untoward effects under the same circumstances. " This constitutes the 
therapeutic ratio, and is a more significant index of a drug's usefulness and 
safety than any other factor. For the therapist, it weighs the effects he 
seeks against the untoward reactions he fears. " Variations of chemical struc- 
tures are perpetually being studied in attempts at improving the therapeutic 
ratio. 

The error of dosage is probably as frequent a cause of therapeutic 
failure as error in selection of the drug. Full therapeutic effects of the use 
of any drug are mandatory. "Enthusiasm as the only governor of the dosage 
regimen leads to disaster. " Tailoring the dose to individual needs requires 
patience and experience and may be altered by the patient's condition and the 
influence of the condition on reactivity and elimination of the drug; on the 
mode of elimination and possible alteration of that function; the desired curve 
of action of therapy; limiting factors of dosage spacing; and — perhaps most 
important — individual constitutional reaction to the drug. 

The average dose, meaning not the average of dose given to all patients, 
but rather the dose given to the average patient under average circumstances, 
is that which experience has shown produces desirable results without toxic 
effects. This dose can have wide range with some drugs, as penicillin, or 
more limited range with other drugs, as streptomycin. With consideration 



Medical News Letter, Vol. 34, No. 4 



of the previous features discussed, the dosage schedule determines the re- 
sults of therapy. 

To aid the practicing physician in his evaluation of the reports on new 
drugs, certain features of these reports need to be identified. The resolution 
of potential external forces on the patients of the clinical trials, such as changes 
in weather or even the turn of world affairs must have been considered. In other 
words, randomization should have been complete enough to eliminate external 
forces as affecting the results of observations. 

Psychic forces often alter the course of the disease. All ramifications 
of this possible influence must have been considered, even to placebo effects 
of treatment. Enthusiasm or lack of enthusiasm exhibited in the ministration 
of the therapy on trial can produce effects on over-all evaluation. Therefore, 
the double-blind study is a valuable technique for making reliable conclusions. 

Careful selection of appropriate subjects for evaluation of a drug under 
test is essential for producing worthwhile results. No less important is the 
appropriate dosage schedule But probably the most important is the applica- 
tion of appropriate controls. Whether large numbers of alternating cases are 
employed or, under special circumstances, one patient serving as his own 
control under changing conditions, the important consideration is whether the 
control was a sound basis for comparison. 

Attention to the details of collection of data reflects reliability of reports 
on drug evaluation, and the care with which statistical analysis of this data is 
made determines the value of the entire report. The reporting of nonsignificant 
data often can lend an air of authority or value to something without value. A 
trend or a difference which has not .been proved to be significant is often mis- 
leading and should not be included in any report. 

How, then, should the busy practicing physician select the best drug? 
'The physician must listen to unbiased voices as well as try to make substantial 
estimates of drug utility on his own. " Medical literature is usually a reliable 
source of adequate evaluation since the busy practitioner does not have the time 
to conduct controlled experiments. However, there is usually a considerable 
lag between appearance of the new drug and comprehensive reviews in the med- 
ical journals attesting to its worth. Before that time, then, reliance must be 
placed on information that the drug manufacturer has compiled in relation to 
the preparatory steps for marketing the product. Publication of this work is 
required by law. Experiences with older drugs of the same pharmacologic 
family give some clues for evaluation, although such experience is not entirely 
dependable because slight structural alterations can result in widely divergent 
pharmacologic action. 

A final admonition is: "Do not use a new drug in combination with other 
drugs; no plan of investigation is more certain to obscure the merits or disad- 
vantages of the new drugs. " (W. Modell, The Basis for the Choice and Use of 
New Drugs: GP, XX: 129-137, July 1959) 

***** * 



Medical News Letter, Vol. 34, No. 4 



Prevention of Rabies in Man 

Writing from the National Institutes of Health, the author points out 
that, although only 5 to 10 deaths from rabies are reported annually in the 
United States, the viral disease is still a public health problem. Each year 
6, 000 or more rabid animals are reported and at least 50, 000 patients receive 
rabies vaccine. Yet, the average physician has had relatively little experience 
in dealing with specific problems that arise in determining the proper course of 
action at the time of a possible exposure to rabies. 

Although the dog is man's chief source of exposure to rabies, proper 
methods of control and vaccination can effectively eliminate canine rabies from 
a given area. With gradual decrease in the number of rabid dogs, there has 
been a growing awareness of a considerable reservoir of rabies in foxes, skunk 
and bats. 

The specific prophylaxis of rabies has been a standard medical procedui 
since the days of Pasteur, with recent research leading to refinements and inno 
vations. Two steps are to be taken immediately when a human being is bitten b* 
any animal: (1) identification and apprehension of the biting animal, and (2) trea 
ment of the wound. 

Observation of any animal for 10 days gives information that allows a 
selection of treatment. Clinical diagnosis of rabies or suspected rabies in the 
biting animal is sufficient indication to start treatment, although absence of 
Negri bodies in the brain smears does not rule out the diagnosis. If the animal 
is healthy 10 days after the bite, the possibility that rabies could have been trar 
mitted is eliminated in all cases except bites by bats. In this case, the bat shoi 
be killed immediately for laboratory examination and treatment started. 

If the biting animal cannot be apprehended, the clinician can only as sum 
that the animal may have been rabid, particularly when occurring in an endem- 
ic area. Local therapy of the bite wound includes the encouragement of free 
bleeding, thorough mechanical cleansing, using soap or detergents and water, 
and fuming nitric acid in deep puncture wounds — all without suturing if pos- 
sible. In bites by known rabid animals, local infiltration of up to 5 ml. anti- 
serum is recommended. 

Bites that are deeply penetrating, severely traumatic, or multiple should 
be considered severe exposures regardless of location, as should any bite on 
the head or neck. In these cases, because of short incubation period, treatment 
should be started immediately without regard to the status of the biting animal 
at the time of the bite. A single dose of antiserum should be given at once. 
Administration of vaccine should be started if antiserum is not available. 
If the biting animal remains normal, no further treatment is necessary. If 
vaccine therapy has been started and the animal is normal 5 days after ex- 
posure, further administration of vaccine is not indicated, provided the 
animal remains well during the 10-day observation period. When the animal 
is known to be rabid, rabies antiserum is given immediately, followed by 
daily doses of vaccine for Zl days. 



10 Medical News Letter, Vol. 34, No. 4 



When the exposure has been mild, and the biting animal is normal, no 
specific prophylaxis is started. But, when the animal is definitely rabid, 
administration of daily doses of vaccine for a period of 14 days is indicated. 

Discussion of rabies antiserum, rabies vaccine, and vaccine -induced 
complications is included in this report which should be referred to for these 
features as well as for more detailed descriptions of recommended manage- 
ment of various problems incident to animal bites. (Habel, K. , Prevention 
of Rabies in Man: Postgrad. Med., 25_: 708-712, June 1959) 

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Survival in Acute Leukemia 

During recent years, a variety of anti -leukemic agents have been 
introduced with an apparent increase in longevity of patients. However, only 
statistical analysis would be expected to confirm the impression. The auth- 
ors compared various factors involved in survival in two groups of patients 
treated at their clinic — the one group being treated between March 1954 and 
December 1957 (89 patients) and an earlier group (78 patients) being treated 
during 1947 to 1954. From earlier study, it was apparent that treatment 
prior to 1954 had not significantly prolonged life except for one-third of the 
patients who achieved complete remission. A significant factor in the series 
treated since 1954 is the introduction of 6-mercaptopurine. 

The authors' analysis revealed a significant increase in survival of 
the later group, with one -half of the patients living more than 8 months after 
symptomatic onset of disease. Measured from the date of onset of treatment, 
the median survival was 6 months which was double that of the earlier group. 
In relation to the various types, those patients with lymphoblastic leukemia 
showed the most significant increase in survival. Prognosis for children 
seemed to be more improved than that for adults, paralleling the increased 
longevity of those with lymphoblastic type which occurs more frequently in 
children. Survival in those patients with lymphoblastic leukemia was also 
greater when there was a low leukocyte value prior to therapy, while those 
with the myeloblastic type showed no such relationship. The employment of 
three anti -leukemic agents contributed significantly to the increased longevity 
figures as compared to results when only one or two agents were used. Use 
of 6-mercaptopurine in some series seemed to be the significant factor when 
a combination of agents was employed, but the fact was not borne out by ana- 
lysis of the entire series, judging by median survival time. 

In conducting this study, special emphasis was placed upon three 
aspects: (1) consistency in clinical management and record keeping; (2) objec- 
tive classification of acute leukemia on morphologic grounds alone; and (3) con- 
servative statistical treatment and interpretation. Therefore, the results of 
the study were considered to be justifiably significant. 



Medical News Letter, Vol. 34, No. 4 11 



In evaluating the advantages derived from therapeutic agents intro- 
duced during recent years, the authors present the following conclusions: 
,! The question of whether to prescribe palliative therapy is no longer a prime 
consideration, for the temporary abeyance of symptoms afforded by drug- 
induced remissions in acute leukemia is well recognized and obviously de- 
sirable. We have noted above that palliative therapy has improved the out- 
look in acute leukemia even without limiting consideration to those patients 
achieving a complete remission. In addition, it is possible that some of the 
small gains found for certain groups may represent a real improvement and 
indicate the trend, even though statistical significance could not be shown. 
Palliative chemotherapy thus has its place, and trials of palliative agents 
can contribute to longevity while definitive therapy or prophylaxis is sought. 
It is quite clear that special effort will be required to achieve better results 
in myeloblastic leukemia. " (Haut, A. , Altman, S. J. , M. M. Wintrobe, M. D. , 
The Influence of Chemotherapy on Survival in Acute Leukemia - Comparison 
of Cases Treated During 1954 to 1957 with Those Treated During 1947 to 1954: 
Blood, XIV: 828-845, July 1959) 

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Treatment of Hypercholesterolemia 

A relationship between the level of blood cholesterol and develop- 
ment of atherosclerosis remains conjectural, although statistical evidence 
tends to make it definite — at least in the United States. The relationship 
between a high fat diet and hypercholesterolemia is more definite, yet it 
would be extremely difficult to indoctrinate the people of areas of high 
standards of living toward a radical change of diet. Some means of alter- 
ing the relationship of fats, cholesterol, atherosclerosis, and coronary 
artery occlusion without essential alteration of the diet would seem to be 
the answer to the problem of the increasing incidence of coronary artery 
occlusion. 

The authors present a study of the effect on serum cholesterol and 
phospholipid levels of higher 4, 5, and 6 double bonded fatty acids as there 
have been indications that they exhibit a greater cholesterol depressant 
effect than those with 2 or 3 double bonds. More highly unsaturated fatty 
acids are more effective in raising total blood unsaturated fatty acid level 
to a "normal" range at which level the greatest reduction of cholesterol is 
reached. Lenic Complex, a stable and not prohibitively expensive prepara- 
tion obtained from crude glycerides and phosphatides from animal, fish, and 
vegetable sources was used, with and without nicotinic acid. 

Reduction of the atherogenic cholesterol :phospholipid ratio was noted 
in about 80% of the 50 patients used as subjects, employing Lenic Complex, 
with a demonstrable synergistic relationship between Lenic Complex and 



12 Medical News Letter, Vol, 34, No. 4 



nicotinic acid. No significant side effects of either substance was encoun- 
tered. In relation to the disagreement as to significance of the cholesterol: 
phospholipid ratio, the authors believe the evidence indicates that a 1:1 ratio 
is the desired "normal" under which condition the proper colloidal solution 
of cholesterol in the blood plasma is maintained to prevent undue precipita- 
tion of more unsaturated cholesterol esters in tissues of the body. Their 
employment of JLenic Complex and nicotinic acid resulted in a shift of the 
ratio to "normal" in 34 of the 50 patients. A point stressed by the authors 
is that, although actual cholesterol levels may persist above an accepted 
level of 220 to 250 mg. , the maintenance of a normal atherogenic index is 
more important than the level of cholesterol alone. 

The biochemical mechanisms involved in the interrelationship of the 
fatty acids, phospholipids, and cholesterol are extremely complex, but a 
brief and simplified explanation is presented. (Worne, H. E. , et al. , 
Lenic Fatty Acid Complex in the Treatment of Hypercholesterolemia: Am. 
J.M.Sc, 238 : 45-53, July 1959) 

****** 

Occlusive Disease of the Carotid Arteries 

The increasing employment of arteriography has contributed to some 
changes in the concepts of etiology, diagnosis, and therapy of "strokes" as 
a result of recognition of the frequency of carotid artery occlusion. This 
condition has a reported incidence up to 9- 5% in unselected autopsies, with 
39% of patients with cerebrovascular disease .having significant carotid 
stenosis. The arteriogram may demonstrate occlusion in 14 to 21. 5% of 
patients presenting the clinical picture of a "sroke. " Atherosclerosis — as 
woul He expected — is considered to be the most frequent cause. 

The clinical features of carotid artery occlusion mimic those of 
many other conditions, such as the features of a slowly growing cerebral 
neoplasm or the catastrophic changes of a middle cerebral artery occlusion. 
Many patients may present recurring and intermittent symptoms which are 
usually considered to be occlusive phenomena of "transient ischemic attacks. ' 
This feature is also confusing a.s it may be seen in developing brain tumor. 
Some "textbook" signs are not as common as might be considered, including: 
transient monocular blindness with contralateral hemiplasia; ipsilateral optic 
atrophy; and dilatation of superficial vessels of the face. In the series of the 
report, the authors found that palpation of the carotid pulse in the neck and 
auscultation of the carotid artery or identification of an intracranial bruit 
were of infrequent value while the measurement of the retinal artery pres- 
sures and observations on manual compression of the contralateral carotid 
artery were of more consistent value in making the diagnosis. 

Carotid arteriography — particularly with the newer contrast media — 
is considered the principal diagnostic procedure, with currently diminishing 



Medical News Letter, Vol. 34, No. 4 13 



hazards. The value of eliminating the possibility of space-occupying lesions 
adds importance to the desirability of the procedure. Following appropriate 
preliminary study, it provides an accurate method for diagnosis of a con- 
dition demanding prompt definitive measures. 

The currently accepted measures of therapy are anticoagulation and 
reconstructive procedures of the occluded vessel. In patients with complete 
vascular occlusion and maximal neurologic deficit, anticoagulant therapy is 
usually not employed, although the authors' experience in one instance 
showed partial patency on repeated angiography following such therapy. The 
point has not been settled, although it would seem logical to assume that there 
is some prophylactic benefit to be gained despite unilateral occlusion. Evi- 
dence does indicate that those patients presenting recurrent ''ischemic" attacks 
are benefited, although it must be stressed that this clinical picture is not path- 
ognomonic of arterial occlusion alone. Furthermore, in the presence of caro- 
tid artery occlusion, reduction of occurrence of cerebral artery occlusions may 
be achieved by anticoagulants. 

Five currently reported means of reconstruction for carotid occlusion 
are: (1) side-to-side anastomosis between the external and internal carotid 
arteries; (2) thrombectomy; (3) thrombo-endarterectomy; (4) resection of the 
occluded portion of the carotid artery and end-to-end anastomosis, or re- 
placement with a venous graft, or internal-external carotid anastomosis; 
and, (5) bypass grafts made of nylon, dacron, or a homograft. Experience at 
this time does not allow adequate evaluation of any of the procedures, although 
it would seem that little is to be gained from the first and second procedures. 

Both forms of therapy have been shown to benefit the acute complete 
occlusion and the slowly progressive type while both have been ineffective 
with the long-standing complete occlusion. Further experience will be expect- 
ed to yield more clear-cut indications for specific therapy. (Silverstein, A. , 
Occlusive Disease of the Carotid Arteries : Circulation, XX : 4-13, July 1959) 

;|< >[; ;!; $ . # >!< 

Prognosis for Rehabilitation in Strokes 

Appalled by the lack of information and interest on the part of physicians 
in general in relation to rehabilitation of the hemiplegic patient, and the usual 
attitude of frustration and hopelessness of the physician as well as the family 
of the hemiplegic patient, the author undertakes to campaign for enlighten- 
ment and presents some simple guidelines for evaluation for rehabilitation of 
patients with strokes. 

The determination of the potential benefits of a rehabilitation program 
for any one individual depends basically upon the presence of three positive 
factors, the absence of two negative factors, the avoidance of two common 
pitfalls, and the prevention of three complications. 



14 Medical News Letter, Vol. 34, No. 4 



Positive Factors . ( 1) Degree of previous activity. Those invalided 
or physically inactive before the stroke probably will not be good candidates 
for rehabilitation. In contrast to this, patients who have been active, ambula- 
tory, and doing their daily chores have the prerequisites concerning previous 
activity and in most instances will do well. (2) Cerebral function. The de- 
gree of each patient's ability to cerebrate in at least a receptive way, to 
cooperate with simple commands, and to possess some power of learning and 
memory must be carefully assessed. Complete restoration of former mental 
powers is not required. Physicians may consider mild mental confusion, 
memory defects, and aphasia to preclude rehabilitation, but this is often not 
true, since the confusion and memory defects usually involve time and incidents, 
but do not interfere with the execution of direct orders received from a thera- 
pist. Those with receptive aphasia of the auditory type do present problems. 
The aphasic patient should never be pushed to the point of frustration, disgust, 
or depression. (3) Motivation. Many patients have their motivation to get well 
reduced or destroyed through unnecessary delays. Not only have they become 
used to their condition, but many have had complications develop, such as 
frozen shoulders or contractures. If rehabilitation begins at the ideal time — 
within 24 to 48 hours after the accident takes place — motivation remains high. 

Negative Factors . (1) Degree of spasticity. Certain patients do not 
build up enough muscle power to overcome spasticity which may develop and 
continue following the stroke. At times, practical use of the extremities is 
precluded. (2) Neurologic involvement of opposite side. A few patients may 
have mild signs of spasticity and incoordination on the unaffected side. With 
this added handicap, the patient may not be able to walk, or may have dif- 
ficulty in grasping a parallel bar, crutch, or cane. Therefore, the favour- 
ableness of the patient's prognosis is decreased or negated in relation to 
the degree of the problem. 

Common Pitfalls . (1) Visible physical aspect of patient. In many 
instances, it is easy to be misled concerning the rehabilitation potential of 
stroke patients. Their status may appear hopeless because of their prostra- 
tion, lethargy, crying spells, absent dentures, tousled hair, incontinence, 
and so on. The same patient, if put in a chair, dentures inserted, hair 
combed, dry (because a bedpan was offered as frequently as needed), and 
possessing hope of something more in life than a bed existence, would give 
an entirely different impression. (2) Dehydration. The state of hydration is 
extremely important. An apparently completely hopeless case, even appear- 
ing near death, may undergo miraculous change simply as a result of attention 
to hydration. 

Complications. (1) Constant drainage. Catheters should not ^be in- 
serted in the bladder of the hemiplegic patient. The difficulties following pro- 
longed catheterization, including chronic infection and delayed restoration 
of bladder control, often present complications which postpone return to the 
family circle. (2) Bed sores. Attention to dryness of the skin, avoidance of 



Medical News Letter, Vol. 34, No. 4 15 



pressure on the skin, and careful attention to general hydration and nutrition 
must be sustained to prevent decubiti. (3) Contractures. The range of motion 
of all joints, especially those on the weak or paralyzed side of the body, must 
be maintained by putting the joints through a complete range of passive motion 
two or three times a day. 

The outlook for the stroke patient should be one of encouragement and 
optimism, Unfortunately, in most hospitals, the patient with a cerebrovas- 
cular accident is still considered primarily a disposition problem. On the 
contrary, stroke victims present interesting challenges. Something dynamic 
and specific can be done for the patient if the doctor is well informed and 
endowed with vision. (Bonner, CD. , Prognostic Evaluation for Rehabilita- 
tion of Patients with Strokes: Geriatrics, 14: 424-428, July 1959) 

. 

*A 3& ft & & 
T* 1* T" T" T 

Physiology of Dumping Syndrome 

Although gastric resection is now a safe and effective procedure, there 
are certain physiologic disorders which occur following surgery that present 
certain problems and undesirable sequelae of surgery on the stomach. These 
are collectively called postgastrectomy syndromes. Of them, the early post- 
prandial dumping syndrome is the most frequently encountered. This phen- 
omenon, a circulatory disturbance developing a short interval after ingestion, 
may follow any surgical procedure which alters normal gastric drainage and 
even may occur in individuals with intact gastrointestinal tracts, but in whom 
there is a rapid emptying time. This occurrence has been reported from 
5 to 75% in various series. 

The dumping syndrome is characterized by some or all of the following 
postprandial symptoms: weakness, sweating, pallor, nausea, vomiting, epi- 
gastric discomfort, palpitation, dizziness, and diarrhea. These manifesta- 
tions usually develop within 10 minutes after a meal of high osmolarity and 
subside within 40 to 60 minutes. More objective manifestations of the dump- 
ing syndrome have been demonstrated during the period of symptoms and 
include: tachycardia, elevation in blood pressure, increased small intestinal 
intraluminal pressure and motility, electrocardiographic changes, decreased 
plasma volume, decreased plasma potassium and phosphate, increased urinary 
excretion of uric acid, decreased circulating eosinophils, hyperglycemia, 
decreased cardiac output, and increased digital blood flow. Because of the 
diversity of the physiologic alterations and the multiplicity of organ systems 
involved, the pathogenesis of this phenomenon has been ascribed to a variety 
of causes. 

The subjects of the author's study consisted of 20 adult male patients 
who were studied for 6 months to 4 years following distal subtotal gastrectomy 
for benign gastroduodenal ulcerations. Several physiological alterations 



16 Medical News Letter, Vol. 34, No. 4 



confirmed previously reported observations. The cardiac rate was accel- 
erated with the greatest increase occurring in the 20 to 30 -minute period 
after ingestion. The systolic blood pressure rose significantly while dia- 
stolic pressure was not appreciably altered. The electrocardiographic 
changes observed — increased rate, lengthening of QT interval, flattening 
of T-wave, and elevation or depression of ST segment — were those com- 
monly seen with the dumping syndrome. Increase in hematocrit, decrease 
in plasma potassium concentration, and fall in plasma volume were also 
observed. 

The finding of particular interest was that of increased renal blood 
flow. The author's previous concept of pathogenesis of the dumping syn- 
drome was that passage of undigested food into the small intestine caused an 
influx of fluid into the bowel lumen with a resulting decrease in blood volume 
which gave rise to vasomotor symptoms and electrocardiographic alterations. 
While this explanation has seemed logical, it is not unequivocally proven that 
fall in blood volume actually represents fluid loss into the bowel. It is diffi- 
cult to explain why an increase in renal blood flow would occur, for if changes 
were initiated by fall in blood volume, a decrease in blood flow to the kidney 
would be expected. This suggests the presence of some vasopressor sub- 
stance. One agent which is normally present as a result of stress phenomena — 
adrenalin — can produce such changes. Investigation of this hormone is 
under way. 

Among other variations observed, a fall in serum level of potassium 
was an almost constant finding, presumably resulting from deposition of 
glycogen in tissues. This physiologic change might account for fall in urinary 
excretion of potassium despite the presence' of increased activity of the adrenal 
cortex. 

While this study does not solve the pathogenesis of the dumping syn- 
drome, it adds data which indicate that physiologic alterations are more gen- 
eralized than had been appreciated, and supports the concept that the entire 
sequence of events cannot be attributed to a change in plasma volume. The 
diversity of cardiovascular changes can best be explained on the basis of 
some systemically circulating agent which may affect various segments of 
the cardiovascular system. (Morris, G. C. , Jr. et al. , Physiologic 
Considerations in the Dumping Syndrome: Ann. Surg., 150: 91-97, July 1959) 

•t* "V - <pi J*fC ffi Vfi 

Change of Address 

Please forward requests for change of address for the News Letter to: 
Commanding Officer, U. S. Naval Medical School, National Naval Medical 
Center, Bethesda 14, Md. , giving full name, rank, corps, and old and new 
addresses. 



Medical News Letter, Vol. 34, No. 4 17 



Stimulation of Bone Growth 



Temperature and oxygen tension are probably the two most impor- 
tant physical variables affecting living cells. Physiologic alteration of either 
or both of these may influence the rate of growth of bone. Alteration of bone 
growth must be unilateral to be of clinical significance. In theory, growth 
would include: (1) unilateral augmentation of blood flow, (2) unilateral in- 
crease of tissue oxygen tension, (3) unilateral localized heating of the epi- 
physes, (4) application of unilateral distracting force to the epiphysis, and 
(5) unilateral stimulation of the nerve to a growing bone. 

Poliomyelitis is by far the most common cause of a short leg, ranging 
in frequency from 60 to 90% of all cases treated. The severity of paralysis 
seems to be the responsible factor in producing shortening of the bone, and 
does not begin for a year or more after the acute illness. The postpoliomye- 
litic extremity is cool, atrophic, and without good vasomotor control, but 
the minute volume of blood flow through the extremity is not invariably de- 
creased. Other conditions causing a retardation of bone growth include 
infections, tumors, or trauma. 

Stimulation of bone growth has been noted in association with vascular 
disorders of the region, such as congenital diffuse hemangioma, arteriovenous 
fistula, and other conditions, such as chronic Brodie's abscess and neurofi- 
bromatosis (localized). The stimulus to bone growth under these circum- 
stances may be the result of either increased volume flow of blood through the 
region or alteration of oxygen tension to the growing epiphysis. 

The treatment of extremity inequalities by lengthening the shorter 
member has never gained wide acceptance because of the inherent difficulties 
of the procedure. The gain in length may not approach the desired amount 
despite resolution of all attendant difficulties. 

Much experimental work has been carried out on stimulation of bone 
growth since the initial experiments by von Langenbeck in 1869, wherein he 
implanted a foreign body in the marrow cavity of a dog femur. Variations 
of this stimulus were employed by others over ensuing years with no reported 
increase of length of more than 5 mm. Recent work has conclusively demon- 
strated that this method is of little or no value. Similarly, drilling of the 
metaphysis and loosening of the diaphyseal periosteum have been of no value 
in stimulating bone growth. 

A new procedure employed recently showed growth in bones of dogs 
from 4 to 15 mm. , and consisted of fracturing the radius and ulna close to the 
epiphysis, followed by epiphyseal distraction through skeletal distraction. This 
process presented problems, however, and clinical trials have not been carried 
out. Unilateral sympathectomy resulting in stimulation of bone growth has not 
proved successful and the procedure has been abandoned. Attempts of stimula- 
tion of circulation to a region by the production of venous stasis have 



18 Medical News Letter Vol. 34, No. 4 



likewise produced no appreciable results in bone lengthening. Bone length- 
ening as the result of an arteriovenous fistula is an accepted fact, although 
the means certainly are obscure at this time, A few surgeons have elected 
to augment bone growth by the production of an arteriovenous fistula. The 
average increased growth was between 1 and 3 cm. and was considered to 
result from the increased temperature and increased vascularization at the 
epiphyses. 

Based on theoretical considerations and the light of clinical observa- 
tions, the authors studied the effects of unilateral bone heating on bone growth. 
Heating was achieved by a few turns of nichrome wire through which was sent 
an alternating current of approximately 1.1 volts. This was enough to elevate 
bone temperature by 2° C. without raising general body temperature and in 
no way interfered with general metabolism and nutrition of the animal. Con- 
trolled heating and histological evaluations were carried out on 17 rats and 
7 dogs. The average length increase was 5% with a 15 to 20% increase in 
weight of the bone, and an increase in the circumference of the bone as well. 
Precise physiological studies were not carried out, but injection studies of 
the circulation were completed and hypertrophy of the arterial and venous 
circulation was obvious- 
Prolonged heating resulted in complications, principally fractures of 
the shaft of the bone. The fracture healed without difficulty and s.tudy of the 
excised specimen suggested that the fracture was related to an overgrowth 
of bone against the resistant nichrome wire. Occasional concentric thicken- 
ing of the shaft of bones was noted, and on microscopic study the heated bone 
showed no alteration of bone architecture. 

Following the initial study, effects of internal heating on healing of 
fractures was observed in 3 dogs. The heated side healed with solid bony 
union and more profuse callus formation than the unheated side. These 
initial observations suggest that this method of internal heating might be 
applied to the stimulation of fracture healing in adult human beings and in 
correction of delayed and nonunions. The rate of chemical reactions and the 
local blood supply would both be increased by this process. (Richards, V. , 
Stofer, R. , The Stimulation of Bone Growth by Internal Heating: Surgery, 
46: 84-95, July 1959) 

$ ?{: 4 JJF & . $ 



BuMed Film Awarded 
International Film Festival Certificate 

The Department of the Navy was recently awarded, an exhibition cer- 
tificate from officials of the International Film Festival in Venice, Italy, for 
the Bureau of Medicine and Surgery film, "Color Vision Deficiencies, '' 



Medical News Letter, Vol. 34, No. 4 19 



Rear Admiral Bartholomew W, Hogan, Surgeon General of the Navy, 
to whom was forwarded a copy of the certificate and a photograph of the pre- 
sentation ceremonies for the files of the Bureau of Medicine and Surgery, 
received the following explanatory comments from the Commanding Officer 
of the U.S. Naval Photographic Center, Naval Air Station, Anacostia, Md. 

"United States Government films entered in the Venice International 
Film Festival competition are very few in number. They are selected 
by the Inter-Departmental Committee on Visual and Auditory Materials 
for Distribution Abroad, under the chairmanship of the United States 
Information Agency. An international jury of film experts at Venice 
then selects the best films from thirty or more countries for exhibition 
and certification. It is an accomplishment for a Navy film to be chosen 
as among the best of the films of all government agencies, and of course, 
a much higher honor to achieve the final exhibition. This recognition is 
justly deserved and is a source of great satisfaction to this command. 

The original certificate, now on display at the Naval Photographic 
Center, was presented by Doctor Gabriele Paresce, Counselor of the 
Italian Embassy, to the U.S. Navy at a recent ceremony at the United 
States Information Agency. I was honored to accept the certificate for 
the Navy. " 

Note: 'Color Vision Deficiencies" (MN 8Z46), 20 min. , 16 mm. , sound and 
color, was made for the Navy in 1957 by Audio -Productions, New York City. 
It was prepared for instruction of Medical Department personnel responsible 
for administering color vision tests. 

****** 
Words of Approbation 

Rear Admiral Bartholomew W. Hogan, Surgeon General of the Navy, 
recently received a letter from a Reserve officer, an Assistant Professor 
in a University Department of Surgery. The Surgeon General considered 
that some. of the remarks of this officer would be of interest to all Medical 
officers. 

"Dear Admiral Hogan: 

A recent spell of training duty has encouraged me to put in writing 
. . . (an expression of) a hearty personal delight in the pattern of activity 
of the Medical Department over the past several years. As a Reserve 
Medical officer ... I can hardly speak with authority, but . . . words 
of thanks and approbation may be as welcome to you as requests and 
criticism 



20 Medical News Letter, Vol. 34, No. 4 



Most striking of all favorable aspects, the career officers appear to 
be finding opportunities to express their professional attainments in the 
highest standards of performance. It is most reassuring to find them 
among the leading figures in various phases of medicine, particularly in 
areas of special interest to the Navy. As a result, the tenor of the Naval 
hospitals, of the various medical publications, and of official notices 
seems to be directed towards taking care of the sick and furthering good 
medicine, while at the same time preserving the stature and purpose of a 
military organization. Achieving such a balance is a rare feat, but is, 
as the present proves, entirely possible. . 

Such attitudes of progressive improvement and leadership in the field 
are most rewarding to those Reserves who have retained a loyalty and 
affection for the Navy outlasting terms of obligated service. . . . We 
all prefer to justify pride on grounds of excellence in addition to those of 
sentiment. Teaching, as I do, in a medical school, I can have no hesitation 
in saying to students, colleagues, and friends that the spirit and caliber of 
Navy medicine has reached a high level that contributes to, and stimulates, 
the entire medical effort of our country in addition to serving the Navy. 
. . . We all benefit from the success and enlightened policies of the Navy 
Medical Corps. . . . May the Medical Corps continue its successful 
ministering to the growth and excellence of medical care throughout the 
land. ..." 

*.U <S* «JU M* *A* 

,»pt 0f* v\1 <Jfm >pi 

Film Release 
Medical Defense Against Chemical Warfare 

Two new color films in the Medical Department series bearing the 
general title, "Medical Defense Against Chemical Warfare" (MN-8266), now 
being distributed are: "Detection of Contaminated Water" (MN-8266b), and 
"Detection of Contaminated Food" (MN- 8266c). 

The new films, each 20 min. in length, are for personnel of the 
Medical Department and of service forces who may be required to test food 
and water supplies for contamination immediately after a chemical-warfare 
attack. "Detection of Contaminated Water" shows the AN-M2 Water Testing 
and Screening Kit and demonstrates step by step the techniques of its use in 
testing for arsenicals, mustards (including nitrogen mustard and cyanogen 
chloride), and G-agents. It also demonstrates its use in the determination 
of chloride demand and pH. Similarly, "Detection of Contaminated Food" 
shows the use of the AN-M2 Food Testing and Screening Kit in making 
detector-crayon tests and tests for arsenicals, mustards (including cyanogen 
chloride) and G-agents. 

Other films in this series previously released are: "Basic Plan for 
Handling Casualties" (MN-8266a), and "Gas Attack Self-Aid" (MN-8266d), 



Medical News Letter, Vol. 34, No. 4 21 



both of which were described in the Medical News Letter, Vol. 32, No. 12, 
Page 21, 19 December 1958. 

Prints of all four films are being distributed to Naval Hospitals, 
Hospital Corps Schools, District Training Aids Sections and Libraries, and 
Marine Corps Training Film Libraries. If prints are not available through 
the usual source address inquiry to Film Distribution Unit, Training Division, 
Bureau of Naval Personnel, Department of the Navy, Washington 25, D. C. 

jjs 5[S $ $ $ $ 

The New Look Ophthalmic Frame 

The P-3 shape ophthalmic frame, which has been the standard issue 
item for approximately 10 years, is being replaced by a more modern design, 
the S-7 frame. The "New Look" ophthalmic frame — recently standardized — 
has a difference of 7 mm. less in the vertical than in the horizontal meridian, 
thus the name, S-7. 

Presently, both P-3 and S-7 frames are being issued. The P-3 will 
be issued until present stocks are exhausted. It is anticipated that all sizes 
of the S-7 will be issued as the standard frome by 1 August 1959. 

The P-3 spectacle fronts and temples were assembled at the factory 
and combination of the two were stocked as a single unit. Prescriptions were 
fabricated according to bridge and eye size requested on the DD-771 and unless 
specifically ordered otherwise spectacles were supplied with the temple lengths 
as procured from the factory. In most instances, therefore, it was unneces- 
sary to state temple length on the DD-771 (Spectacle Order). 

The S-7 spectacle front is stocked as a single unit and two types of 
temples, spatula or riding bow, are stocked as individual units. To insure 
proper fit for the patient and to provide adequate fabrication data for the 
laboratory it will be necessary to indicate on the Spectacle Order (Form DD-771) 
the bridge size, eye size, temple length, and temple style (spatula or riding 
bow) along with the pupillary distance (distance and near). 

Listed below are tb*= available S-7 frame sizes and temple lengths. 

to a me sigES 



Eye 


Bridge 


Ere Bridee 


Ere Bridee 
46/39 x 20 


Eye 


Bridee 


42/3 5 


x 18 


44/37 x 18 


48/41 


X 20 


4-2/35 


x 20 


44/37 x 20 


46/39 x 22 


48/41 


x 22 


42/35 


x 22 


44/37 x 22 


46/39 x 24 


48/41 


x 24 


42/35 


x 24. 


44/37 x 24 


46/39 x 26 


43/41 


x 26 


42/35 


x 26 


44/37 x 26 


-r 










TEMPLE LENGTHS 








(measured from hinge tc 


) crest (top) of 


ear) 






Spatula 


Tem@le 


Ridine Bow 


Temole 






4 " 


4-3/4" 


4 ■ 


4* 






44" 


5" 


44- 


5 " 





4±" 

Ophthalmic Lens Laboratory, Williamsburg, Va. 



22 Medical News Letter, Vol. 34, No. 4 



Postgraduate Short Courses at 
Armed Forces Institute of Pathology 

Postgraduate short courses for Medical Corps officers, sponsored 
by the Armed Forces Institute of Pathology, Washington, D. C. , will be 
given during Fiscal Year I960 as indicated below. Eligible officers are 
those who meet the criteria prescribed by BuMed Instruction 1520. 8. 

Eligible and interested officers should forward requests via official 
channels, addressed to the Chief of the Bureau of Medicine and Surgery, to 
be received in the Bureau at least 6 weeks prior to commencement of the 
course requested. Travel and per diem orders chargeable against Bureau 
funds will be authorized for those approved for attendance. 

Courses Dates 

Application of Histochemistry of Pathology 26-30 Oct 1959 

Forensic Pathology 8-13 Nov 1959 

Pathology of Diseases of Laboratory Activities . . 7-11 Dec 1959 

Pathology of the Oral Regions 14 - 18 Mar I960 

Ophthalmic Pathology 28 Mar to 1 Apr I960 

# * # # # * 

Board Certifications 

American Board of Dermatology 

CAPT Dale B. Watkins MC USN 

American Board of Internal Medicine 

(Internal Medicine and Gastroenterology) 
CAPT James H. Boyers MC USN 

American Board of Neurological Surgery 

LCDR Benjamin L. Crue, Jr. , MC USN 

American Board of Obstetrics and Gynecology 
CDR Wendell A. Johnson MC USN 

American Board of Orthopedic Surgery 

CDR Frank L. Golbranson MC USN 

American Board of Otolaryngology 

CDR Fred A. Valusek MC USN 

American Board of Psychiatry and Neurology in Psychiatry 
LCDR Hans G. Preuss MC USNR (Active) 



Medical News Letter, Vol, 34, No. 4 23 



American Board of Radiology 

CDR Garner L. Lewis MC USNR (Active) 
CDR Robert W. Spicher MC USN 

American Board of Surgery 

LCDR Robert I. Garrett MC USN 
CDR Joseph L. Whatley MC USN 

American Board of Thoracic Surgery 

CAPT Horace D. Warden MC USN 

$e 3^ j(c # jjc -A 

IN MEMORIAM 

CAPT Edward B. Hopper MC USN 30 June 1959 

CAPT Lou C. Montgomery DC USN (Ret) 15 July 1959 

CAPT George N. Schiff MC USN (Ret) 3 August 1959 

CAPT Griffith E. Thomas MC USN (Ret) 3 August 1959 

CDR Joseph C. Fagan MSC USN (Ret) 24 May 1959 

CDR William L. Strangman DC USN (Ret) 9 April 1959 

CDR Howard A. Tribou MC USN (Ret) 22 July 1959 

LCDR Grace E. Beach NC USN 21 July 1959 

LCDR Ernest N. Grover MSC USN 24 May 1959 

LCDR Mary O'Neill NC USN 24 July 1959 

LCDR Elizabeth (V) Warner NC USN 11 June 1959 

LT Frank (N) Bosse MSC USN (Ret) 30 June 1959 

WO Sigfred E. Smith MSC USN (Ret) 26 June 1959 

s)c :$r jJE sjc j{c iji 

Recent Research Reports 

■ .- - ■ 

Naval Medical Research Institute, NNMC, Bethesda, Md . 

1, Isolation and Characterization of Deposits of Secretion from the Acetabular 
Gland Complex of Cercariae of Schistosoma Mansoni. NM 52 02 00. 01.04, 

25 March 1959. 

2. Metabolic Activity in Calcified Tissues: Aconitase and Isocitric Dehydro- 
genase Activities in Rabbit and Dog Femurs. NM 75 01 00.02.03, 6 May 1959. 

Naval Medical Research Unit No. 3, Cairo, Egypt 

1. Lyophilized Glycerol Pectate - Lot 18 for Plasma Volume Replacement 
and Expansion. NM 71 07 03. 1.01, September 1958. 



24 Medical News Letter, Vol. 34, No. 4 



Naval Air Development Center, Johnsville, Pa . 

1. A Study of the Effects of Positive Acceleration upon Erythrocyte Hydra- 
tion in Human Subjects. NM 19 02 12.2, Report No. 1, 12 May 1959. 

2. Effect of Temperature on Tolerance to Positive Acceleration. NM 19 01 
12.1, Report No. 16, 26 May 1959. 

3. G Tolerance in Primates. II. Observations on the Relationship of Carotid 
Pressure and End Point during Acceleration. NM II 01 12. 9, Report No. 2, 
29 May 1959. 

4. Preliminary Studies on the Mechanism of Radiation Damage to Oxidative 
Phosphorylation in Spleen Mitochondria. NM 00 01 12. 7, Report No. 6, 

9 July 1959. 

Naval Medical Field Research Laboratory, Camp Lejeune, N. C . 

1. Effect of Environmental Factors on the Performance of Marine Corps 
Personnel. Pilot Study: The Use of Performance Tests and Questionnaires 
to Differentiate between Types of Body Armor - A Preliminary Investigation. 
NM 41 03 09, June 1959. 

Naval Medical Research Laboratory, Submarine Base, New London, Conn . 

1. Bibliography of Sensory Deprivation, Isolation, and Confinement. Memo- 
randum Report No. 59-1, NM 23 02 20.03.02, 4 May 1959. 

Naval School of Aviation Medicine., NAS, Pensacola, Fla . 

1. Effect of Exposure Time upon the Ability to Perceive a Moving Target. 
NM 17 01 11, Report No. 2, Subtask No. 2, 6 January 1959. 

2. Speaker Intelligibility: A Note on the Effect of Monaurally Delaying 
Airborne Side-Tone. Joint Project NM 18 10 99, Report No. 84, Subtask No. 1, 
15 January 1959- 

3. Some Effects of Differential Pressures Applied to the Head and Body of 
Rats. NM 12 01 11, Report No. 4, Subtask No. 5, 29 January 1959. 

Naval Medical Research Unit No., Z, Taipei, Taiwan 

1. Epidemiologic Studies of the 1958 Cholera Epidemic in Bangkok, Thailand. 
NM 52 11 02.3.3, 21 April 1959. 

2. Epidemic Rubella in Taiwan 1957 - 1958. III. Gamma Globulin in the 
Prevention of Rubella. NM 52 05 02. 1.2, 20 May 1959. 

3. Intestinal Protozoans and Helminths in U.S. Military and Allied Per- 
sonnel, Naval Hospital, Bethesda, Md. , NM 52 11 02. 1.3, 27 May 1959. 

4. Epidemic Keratoconjunctivitis (E, K. C. ). Part III. Adenovirus Isolation 
fromE.K. C. NM 52 05 02 10.2, 4 June 1959. 



Medical News Letter, Vol. 34, No. 4 25 



From the Note Book 



MC Flag Selections . The selection of three Navy Medical Corps Captains 
for promotion to the rank of Rear Admiral was approved by President 
Eisenhower on 27 July 1959. Those selected were: Captain James L.Holland, 
Staff of the Commander, Naval Air, Pacific; Captain Cecil L. Andrews, 
Commanding Officer, U.S. Naval Hospital, St. Albans, N. Y. ; and Captain 
Cecil D. Riggs, Commanding Officer, U.S. Naval Hospital, Chelsea, Mass. 
Their appointments to flag rank will be made as vacancies occur. 

AFIP Director to Retire . Captain W.M. Silliphant MC USN was relieved as 
Director, Armed Forces Institute of Pathology, by Colonel F, M. Townsend, 
USAF (MC) on 1 August 1959. Captain Silliphant served with the Institute for 
7-1/2 years and has been Director for the past 4 years. He will retire from 
active duty on 1 September 1959 and will subsequently join the staff of the 
Cancer Research Institute and the Department of Pathology of the University 
of California Medical Center in San Francisco, Calif. {AFIP Letter) 

Allied Military Nurses . An Annual Military Assistance Naval Training 
Orientation Course for Military Nurses of Friendly-Allied Countries has been 
formulated by the office of the Surgeon General of the Navy and approved by 
the Chief of Naval Operations, with the first class scheduled to convene in 
September 1959. Established in response to several requests from friendly- 
allied armed forces desiring to send nurses to the United States for further 
professional training, the course will be held at the U.S. Naval Medical 
School, National Naval Medical Center, Bethesda, Md. 

Brazilian Congress . Captain Ralph D. Berry MC USN has been named 
representative of the Office of the Assistant Secretary of Defense (Health and 
Medical) and as the Navy Medical Department representative to the Second 
Brazilian Congress on Military Medicine to be held in Port Alegre, Brazil 
during August 1959. Captain Berry is presently assigned in the U.S. Mission 
to Brazil, Rio de Janeiro. 

Aminophylline . Employing a control group, the authors evaluated the effects 
of aminophyllin on two groups of patients with selected types of cardiac and 
pulmonary disease. Their findings were: In normal persons and patients 
with mitral stenosis, coronary blood flow decreased with increased myocardial 
oxygen extraction. The cardiac metabolic rate for oxygen was maintained. No 
evidence of a coronary vasodilatory action was found. (CM. Maxwell, M. D. , 
et al. J. Lab. and Clin. Med. , July 1959) 

Hepatic Encephalopathy . As a result of their evaluation of the effect of two 
ammonia -binding substances, the authors conclude that endogenous ammonia 



26 Medical News Letter, Vol. 34, No. 4 



alone probably is not the sole neurotoxic factor in spontaneous encephalo- 
pathy in patients with severe liver disease. Arterial ammonium levels 
were reduced with increase of cerebral blood flow and oxygenation — all 
vithout significant change in the clinical states of the patients studied. 
{W. K. Young, B. S. , et al. , Am. J. M.Sc, July 1959) 

Cross- Exami nati on . This discussion, prepared by a physician, a lawyer- 
physician, and a lawyer presents many suggestions in relation to the phys- 
ician's position as an expert witness, stressing effective testimony during 
cross-examination. (R, R. Merliss, et al. , New England J. Med. , 23 July 
1959) 

Gastric Ulcer . The author contends that roentgen examination amounts to 
gross examination in vivo with an added dimension, and that it is possible 
for the radiologist to make the distinction between ulcer and cancer in a very 
high percentage of cases. Quoting his study of 100 consecutive proved cases 
of gastric carcinoma with an accurate preoperative x-ray diagnosis in 81%, 
he considers that his opinion is justified. (Israel Kirsh, M. D. , Gastroentero- 
logy, July 1959) 

Temperomandibular Joint . In relation to temper omandibular joint dysfunction, 
the holistic attitude must be adopted by the practitioner to avoid unnecessary 
radical procedures. Frequently, the emotional status of the patient plays 
i total or partial role in the production of the symptoms of this dysfunction. 
Electromyographic, emotional, and anatomical evaluations were made on a 
;eries of patients presented in the report. (W. L. Kydd, D. M. D. , J. A. D. A. , 
July 1959.) 

I3ronchiolar Carcinoma. The new concept that bronchiolar carcinoma may 
arise from bronchiolar adenomatous malformation, in single or multiple foci, 
\s put forth by the authors. The resemblance to the bronchiolar adenomatous 
malformations in photomicrographs and histologic descriptions of reported 
cases of bronchiolar carcinoma is discussed. Whether some of the reported 
cases of bronchiolar carcinoma are indeed malignant neoplasms is questioned. 
(S. L. Eversole, Jr., M. D. , W. F. Rienhoff III, M. D. , J. Thoracic Surg. , 
June 1959) 

Dental Caries . The author of this article presents a theory concerning the 
development of dental caries, based on the heretofore unknown existence of 
glycogen in the dental enamel. He contends that caries is not caused by a lack 
of an element in the diet but by overconsumption, in particular by an excessive 
intake of carbohydrates during the formative period of the teeth. (E. Egyedi, 
M. D. , D.S. , Amsterdam, Holland, Dental Digest, July 1959) 



Medical News Letter, Vol, 34, No. 4 27 



T olbutamide . Reporting from the Royal Victoria Hospital in Belfast, the 
authors concluded from study of patients, that tolbutamide did not alter the 
capacity of exogenous glucagon to produce hyperglycemia. This is in contrast 
to the opinions of others that tolbutamide intensifies the response to glucagon, 
or antagonizes the hyperglycemia effects of glucagon. Their opinion confirms 
the belief that glucagon increases hepatic glycogenolysis by influencing the phos- 
phorylase enzyme system. (C. K. Gorman, M. B. Belfast, J. A. Weaver, M. D. , 
Belfast, The Lancet, 11 July 1959) 

Adrenal in Pregnancy . Jailer et al report increased hydrocortisone in the free 
plasma during pregnancy or estrogen administration. However, there are 
no evidences of hypercorticism, and no suppression of ACTH secretion. In 
view of this paradoxical situation, it is speculated that there must be some 
mechanism whereby a large portion of the hormone is rendered inert iu relation 
to the exertion of inhibitory effects upon the cells of the adenohypophysis or 
widespread metabolic effects upon other tissues of the body. {J. W. Jailer 
et al. , Am, J. Obst, & Gynec. , July 1959) 

Cerebral Palsy . A new meprobamate derivative, Soma, was employed in a 
preliminary evaluation of treatment of cerebral palsy. Improvement in spastic 
patients and those with rigidity was substantially greater than in athetoid patients. 
Dosage was kept at the level required to relax the contractures and not increased 
to the point of causing weakness. There were no adverse effects, and side- 
effects were limited to lethargy or drowsiness. (W. M. Phelps, M. D. , Arch. 
Pediat. , June 1958) 

Radioautography . This technique, making it possible to determine directly 
the distribution of radioactive material in the tissues, was employed to trace 
the distribution of penicillin in various body tissues. A high concentration 
was found in the kidneys, liver, and lungs; only a little was traced in the 
muscles, virtually none in the brain. Between the placenta and the fetus, a 
barrier was evident similar to that between the blood and brain. Penicillin 
penetrated abscess cavities, although in low concentration in chronic cases. 
When renal excretion was blocked with Probenecid, penicillin was eliminated 
through the nasal mucosa and hair follicles. (Med. et hyg. (Switz. ), 17:82 
1959) 

Murmurs . In the problem of differentiation of the pansystolic regurgitant mur- 
murs in the adult which may be due to mitral regurgitation, tricuspid regurgi- 
tation or ventricular septal defect, the authors demonstrate that the employ- 
ment of nor-epinephrin which raises the systemic diastolic arterial pressure 
aids in the identification of the etiology of the sound. With this technique, the 
tricuspid lesion will not manifest any change in character of the murmur while 
the other two lesions will be evident by specific alterations of the sounds. 



28 Medical News Letter, Vol. 34, No. 4 

(L. A. Soloff, M. D, , et al. , The Pansystolic Regurgitant Murmur: A Simple 
Method of Identifying its Anatomic Source: Am. J. M. Sc. , 237: 744-748, 
June 1959) 

Left Ventricular Hypertrophy . Evaluating the reliability of criteria for 
electrocardiographic diagnosis of left ventricular hypertrophy, correlation of 
the features of tracings with anatomical findings was made in 200 successive 
patients who exhibited left ventricular hypertrophy at autopsy. The most sig- 
nificant abnormalities were the characteristic ST-segment and T-wave changes 
which were seen in 55% {80% if patients with obvious myocardial infarction or 
bundle-branch block were excluded. ) Amplitude of the QRS complex was quite 
unreliable with only 22% showing this variation. (A. H. Griep, M. D. , Circulation, 
July 1959) 

Magnesium and Labor . Incident to the use of intravenous magensium sulfate 
in the treatment of toxemia of pregnancy prolongation of labor has been ob- 
served. Assessing the role of the magnesium ion in producing this effect, the 
authors found that magnesium inhibited the contractility of isolated muscle 
tissue excised from gravid human uteri; and in clinical experience, did have 
a depressant action on uterine motility, although this effect did not detract 
from its use as the anticonvulsant of choice in the toxemias of pregnancy. 
(D.G. Hall, M.D. , el al. , Am. J. Obst. & Gynec. , July 1959) 

j)t ^c % . ad sjt jjs 

BUMED NOTICE 6230 22 July 1959 

From: Chief, Bureau of Medicine and Surgery 

To: Ships and Stations Having Medical Personnel 

Subj: Influenza vaccination program for 1 October 1959 - 31 July I960 

This instruction provides information concerning the utilization of polyvalent 
influenza virus vaccine by military activities during 1959 - I960. Vaccine 
shall be administered during October 1959 to all naval personnel on active 
duty; and to personnel who enter on ective duty between 1 October 1959 and 
31 July I960, including those entering active duty for training for periods in 
excess of 30 days. In addition, all dependents 6 years of age and over shall 
be offered the vaccine on a voluntary basis. 

$ .4 & :$ $ . $ 

Use of funds for printing this publication has been approved by the 
Director of the Bureau of the Budget, 19 June 1958. 



Medical News Letter, Vol. 34, No. 4 



29 



DENTAL 




SECTION 



Management of Gagging Patients 

Gagging frequently prevents optimal performance of various dental 
procedures and is troublesome to patients who must wear complete dentures. 

The etiology of gagging and vomiting is believed to be from irritation 
of sensitive areas of the posterior pharyngeal wall, soft palate, uvula, fauces, 
and dorsum of the tongue's posterior portion. Tactile, visual, acoustic, chem- 
ical, olfactory, or psychic stimuli may trigger the gagging reflex. 

In complete denture prosthesis, a well-planned and well-constructed 
denture is essential. Maximum retention, an adequate vertical dimension, a 
sufficient posterior palatal seal, a balanced occlusion, and a correct inter- 
occlusal distance are most important. 

Gagging or vomiting may result from biomechanical factors in the 
construction of the dentures or from psychogenic factors. When, biomechanical 
factors have been eliminated, drugs may be used to deal with the psychogenic 
aspect of gagging and to block stimuli which provoke the gagging reflex. 

A number of drugs may be used to resolve such situations so that 
manipulative procedures may be carried out and the initial resistance to wear- 
ing dentures may be overcome. 

Since the vomiting reflex is a function of the parasympathetic portion 
of the autonomic nervous system, drugs that selectively depress this system 
are useful. Among these drugs are the sedatives, antihistamines, parasym- 
patholytics, and the central nervous system depressants. {M. L,. Schole, B, S. , 
D. D. S. , Excerpts from article, Journal of Prosthetic Dentistry, 9^: 573-583, 
July - August 1959) 

$ $ 1$C 9|E $ $ 

■ 

More About Fluoridation 



The water supplies of 3, 703 communities with a total population of over 
42, 000, 000 people contain fluorine either naturally or through controlled addi- 
tion. This indicates that one of every three people in the country using central 
water supplies now drinks fluoridated water in sufficient quantity to prevent 
two out of three dental cavities, 

# 'C ^ ^ ^ : p 



30 Medical News Letter, Vol. 34, No. 4 



Personnel News 

CAPT R. A. Colby DC USN was elected President-Elect of the 
American Academy of Oral Pathology and CDR H. H. Scofield, Jr. DC USN 
was elected Vice President of the Academy, both for the year 1959 - I960. 

CAPT G. C. Rader DC USN has relieved CAPT R.S.Snyder DC USN 
as Head, Planning and Analysis Branch, Dental Division, Bureau of Medicine 
and Surgery. CAPT Rader, prior to this change, was Assistant Head of that 
branch. 

In a Change of Command ceremony, 30 June 1959, at the U.S. Naval 
Dental Clinic, Brooklyn, N. Y. , CAPT E.J. Holubek DC USN relieved CAPT 
F. W. Lepeska DC USN as Commanding Officer of the U.S. Naval Dental 
Clinic, U.S. Naval Base, Brooklyn, N. Y. 

In consonance with the policy of giving as many officers as possible the 
opportunity for command status, the following changes in commanding officers 
of Naval Reserve Dental Companies became effective 1 July 1959: 

NRDC 12-1 - CDR D.J. Potter (DCR) for CDR C. E. Butler (DCR) 
NRDC 12-2 - CDR B.J. Harris (DCR) for CDR J. V. Shahbazian (DCR) 
NRDC 12-3 - CDR J.H. Ingles (DCR) for CDRR.A. Cupples (DCR) 
NRDC 12-8 - CDR R.A. Whiting (DCR) for CDR M. C. Funk (DCR) 

Dental Service Report (DP 477) 
Errors in Submission 

Numerous errors have been noted in the Dental Service Reports (DD 477) 
and the consolidated DD 477's from submitting activities. Examples of the more 
common errors are: 

Late reporting. Write-in entries not placed in proper classification. 

Examinations greater than patient load. 

Unauthorized treatments (orthodontics) not explained in Remarks Section. 

Incomplete reports. 

Total procedures in error. 

It is essential that close attention be given to the instructions contained 
in Article 6-150, Chapter 6, (Rev.), Manual of the Medical Department, to 
assist in the proper preparation of the Dental Service Report. Closer mon- 
itoring of reports by reviewing officers will do much to eliminate the submis- 
sion of erroneous reports. 

sjt $ jjs ;£ $ ifl 




Medical News Letter, Vol. 34, No. 4 31 



RESERVE SECTION 



Armed Services Orthopedic Seminar 

The first Armed Services Orthopedic Seminar will be convened at 
the U.S. Naval Hospital Oakland, Calif., 23 - 25 September 1959> under 
the sponsorship of the Commandant, Twelfth Naval District. 

Eligible Naval Reserve Medical Corps officers on inactive duty may 
be credited with one retirement point for each day's attendance provided 
registration is made with the military representative present. 

****** 
Annual Meeting of the American Psychological Association 

The American Psychological Association will hold its annual meeting 
at the Sheraton-Gibson and Netherland Hilton Hotels in Cincinnati, Ohio, 
3-9 September 1959. 

Selected sessions considered to have military significance will be 
indicated on the program. These sessions will provide information and tech- 
niques employed in psychology which are not readily available in civilian 
pursuits, but invaluable in the event of mobilization. 

Eligible inactive Naval Reserve Medical Department officers may 
receive one retirement point credit for attendance at each daily session 
provided registration is made with the military representative present. 

$ $ # * * * 
Revision of Promotion Policy 

A change has been made in the policy governing the promotion of 
Naval Reserve officers on inactive duty. Effective with selection boards 
convening in fiscal year 1961, officers will be required to earn 12 retire- 
ment points during their anniversary year which will end in the fiscal year 
immediately preceding the fiscal year in which they would be considered for 
promotion by selection boards. 

The anniversary year for Reservists who were members on 30 June 
1949 extends from 1 July through 30 June, coinciding with the fiscal year. 
However, for those members who entered after 30 June 1949 or whose 
Reserve service was broken after that date, the anniversary year extends from 
the date of entry of reentry. 



32 Medical News Letter, Vol. 34, No. 4 



An example of the latter situation could be the case of an fficer who 
entered the Naval Reserve on 1 April 1950. The anniversary yei - of that 
officer would begin on 1 April and end with 31 March, If he wert in the pro- 
motion zone in fiscal year 1961, it would be necessary for him to have earned 
12 retirement points during the period 1 April 1959 through 31 March I960 
in order for him to be eligible for consideration by a selection board convening 
during fiscal year 1961. 

For fiscal year I960, eligibility for consideration will be established 
by having earned the 12 retirement points during fiscal year 1959 or in the 
anniversary year ending in fiscal year 1959- 

The change in policy is expected to simplify administrative procedures 
at the Reserve Officers Recording Activity (RORA), which posts retirement 
points according to each officer's anniversary year. 

Officers still must earn an average of 24 promotion points for each 
year in grade in order to qualify professionally for promotion, BuPers Instruc- 
tion 1412, ID contains complete details. (The Naval Reservist, May 1959) 

****** 
N ew Identification Cards for Inactive Reservists 

A new identification card system will soon be in effect for Naval per- 
sonnel. Under the new plan, three cards, designated DD Form ZN, will be 

used as follows: 

The identification card printed in green "security-type" ink will con- 
tinue to be issued to members' of the Regular Navy and Naval Reservists 
who are serving on extended active duty. 

An identification card printed in gray "security-type" ink will be 
issued to members of the Regular Navy and Naval Reserve who are en- 
titled to retired pay. 

An identification card printed in red "security-type" ink will be issued 
to Naval Reservists who are not entitled to either the green or gray card. 
Thus, Reservists serving on inactive duty and those who are not retired 
with pay will be issued the red card. 

The buff colored Uniformed Services Identification and Privilege Card, 
DD Form 1173, will continue to be issued to personnel not on extended active 
duty until the new red and gray cards are printed and distributed. 

The availability of the red and gray cards and instructions governing 
their issuance will be announced in a few months. Meanwhile, no action need 
be taken. 

Holders of the buff identification cards, DD Form 1173, will not be 
required to change to the red or gray cards. 

****** 



Medical News Letter, Vol. 34, No. 4 33 



AVIATION MEDICINE DIVISION 




Indoctr iiiatioii and Fleet Evaluation of the 
Navy's Full Pressure Suit 

Many squadrons soon may be receiving the full pressure suits. There- 
fore some information in way of indoctrination may be of assistance. Training 
in the use of this equipment is being given at the Naval Air Station, North 
Island, San Diego, Calif. , and the Naval Air Station, Norfolk, Va. Because 
of the newness and somewhat uniqueness of the full pressure suit and since 
the response to the suit is varied, the indoctrination needs to be tailored to 
each individual. Generally, it requires about three days to fit and indoctri- 
nate pilots. Air group flight surgeons and parachute riggers should accom- 
pany pilots for this indoctrination. 

During the first day, an initial fitting of the suit is made along with 
a medical examination and review of the pilot's medical record. Initial selec- 
tion of a suit is somewhat of a trial and error method since body measurements 
will not reveal exactly which of the twelve sizes will precisely fit the pilot. The 
probable suit, judging from measurements, is tried on the pilot. If it does not 
fit precisely, other sizes are tried until the best fit for the pilot is obtained. 
Following this initial fitting, a forty-minute lecture is given covering a general 
discussion of high altitude flight, anti -immersion protection, crash protection 
and general operation of the equipment. The initial lecture phase is important 
because it is at this time that the pilot recognizes the need for the equipment. 
He must be sold on it as completely as possible to have every confidence in it. 
It is not enough to say to the pilot that he must use the equipment to fly above 
a certain altitude, the instructor must explain why and must document this 
"why" with actual incidents and conditions at high altitude flight. Once need for 
the suit is firmly established and the pilot realizes that the Navy's full pres- 
sure suit is an outstanding development, half of the battle is won. Following 
the lecture, additional adjustments of the suit are made and the ancillary 
equipment (such as the harness, et cetera) is fitted. This is followed by a 
detailed lecture on the suit and its component parts, suit control system, and 
breathing regulator. When it is felt that the pilot understands the suit, he puts 
it on and experiences some sea level pressurizations gradually increased from 
1/8 psi to 1 psi. 



34 Medical News Letter, Vol. 34, No. 4 



The second day is utilized primarily in familiarizing the pilots with 
the suits. This is accomplished by wearing the suits as much as possible 
throughout the day. Sea level pressurizations are given gradiently to 3. 4 
psi in a mockup ejection seat, and while flying an instrument hop in a Link 
trainer. The Link trainer is merely used to keep the pilot occupied while he 
is going through the various pressure stages within the suit. It is during this 
familiarization period that the pace of the "tailored 1 ' type of indoctrination is 
set. The instructor. has to see and feel how far and how fast he can go with 
each individual pilot. When the instructor feels that the pilot is ready, the 
chamber flight is started, which again is "tailored" to the type of aircraft 
that the pilot is flying. If the peak altitude of the aircraft is 60, 000 feet, the 
chamber flight is to 60, 000. The chamber flight also consists of a rapid de- 
compression from 30, 000 to 62, 000 feet. At the end of the program, a review 
and debriefing period is held. 

During a twenty-month period at the North Island unit, approximately 
400 Naval, Air Force, and civilian personnel have worn one of the various 
model high altitude suits. Only three persons were considered to be unadapt- 
able psychologically, and only two persons required specially constructed suits 
because of unusual body dimensions. 

From experience it has been found that several factors are important 
during the indoctrination period. One factor is a personalized treatment. An 
attempt is made to assign one instructor to each pilot. This single instructor 
follows the pilot through the entire period of indoctrination. The second factor 
is the tailoring of the indoctrination. Those pilots who accept the suit and 
training readily are moved along rapidly. Those who are a little hesitant receive 
a slower rate of training. The third, and perhaps most important factor, is the 
absolute necessity for a well trained, confident, and enthusiastic instructor. 
Regardless of the effectiveness of a piece of equipment, its final and 
most severe test is acceptance by the individuals for whom it is designed to 
protect. Fleet evaluation gives valuable information as to the acceptability. 
Fleet evaluation also gives the final test of compatibility of the protective 
equipment, the man, and the area in which the equipment is designed to oper- 
ate. Acceptance and compatibility are particularly important in use of the full 
pressure suit. Occasionally there is "wearing" acceptability during the train- 
ing period, but failure is encountered when the man and his protective equip- 
ment are expected to operate within the confines of an already crowded cockpit. 
Failures also come to light with the accessory equipment necessary to unite 
the man, pressure suit, and aircraft. Much of the earlier evaluations were 
ably accomplished by the Naval Air Test Center and VX-3 of the Operational 
Development F^rce. 

Five pilots of VF-124, Naval Air Station, Moffett Field, were selected 
to act as a fleet evaluation team for the early model Mark II Navy full pressure 
suit. All five accepted the training well and psychologically adjusted to the suit. 
They put in over 80 hours of flight time in the suit with the F8U-1 aircraft and 



Medical News Letter, Vol. 34, No. 4 35 



reported that the suit was safe for flying, but that they could recommend its 
use for training flights only. These same five pilots were than fitted in later 
lightweight Mark III, Model O, full pressure suits and reported only a few 
discrepancies as far as the suits were concerned, but they did want some 
changes in the pilot -to -plane connections (D-500) and the backpack configura- 
tions. During this period, later versions of the integrated torso harness, 
ventilation garment, and helmet were received. With these improvements, 
these pilots reported that the new lightweight suit was acceptable for operational 
use. 

Twenty contract test pilots from Chance-Vought Aviation, McDonnell 
Aviation, Pratt -Whitney, North American, Douglas, and Curtis-Wright were 
issued and indoctrinated in the lightweight Mark III, Model O, full pressure 
suits. There was excellent acceptance and these pilots all reported favorably 
on the suit in flight. 

In December 1958, the VF-142 squadron, Naval Air Station, Miramar, 
Calif. , was the first Navy squadron to be completely outfitted with the full 
pressure suit. The following are being evaluated: (1) flight compatibility; 
(2) storage at the squadron and on the carrier; (3) maintenance; (4) points of 
failure with repeated use; (5) cooling problem during donning, from ready 
room to aircraft, during preflight, and during cockpit hookup and check; 
(6) helicopter rescue procedures; and (7) over-all carrier operations with the 
suit. Pilots of VF- 142 represented a normal cross section of the usual fighter 
pilot squadron and almost all were outfitted in the Mark IV, Model O, Navy 
full pressure suit. Because of size difficulties, a few had to be fitted in the 
Mark III, Model I, Navy full pressure suit. Indoctrination was completed 
prior to their deployment aboard the USS RANGER. 

An interim report submitted by the squadron after each pilot had had 
at least four hours flight time in the suit indicated that they, too, considered 
it satisfactory for operational use. Most of the pilots stated that they would 
rather wear the full pressure suit than the anti-immersion suit. They also 
found the headpiece more comfortable than the A13A mask and APH-5 helmet 
combination and that visibility and head mobility were excellent. 

This report indicated that omni- environmental features of the suit 
should be stressed more during indoctrination. In the past, training seemed 
to overstress altitude protection and to be concerned too briefly with the fine 
anti-immersion protection, crash, heat, cold, and wind-blast protection that 
this equipment affords. Increased flight experience has indicated and brought 
about the following changes: (1) a backpack to a seatpan configuration; (2) re- 
moval of the D-500 with an alternate simpler connecting system; (3) improve- 
ment of integrated harness; (4) sunvisor improvement; {5) improvement on 
entrance zipper and mode of donning; (6) improvement of glove, and (7) improve- 
ment in the headpiece and neck ring. Reports from contract test pilots have 
also yielded valuable information concerning comfort and mobility in relation 
to the fitting of the suit. 



36 Medical News Letter, Vol. 34, No. 4 



The procedure at present is to fit the suit primarily for maximum 
mobility and comfort in the normal flying condition (unpressurized) and to 
take up on the lacing adjustments to decrease bulk, but not at the expense 
of mobility or comfort. When fitted in this manner, the Mark IV suit in- 
creases only slightly in bulk or area dimension when pressurized. The 
cockpit dimensions of the F8U-1, F8U-2, F4H, A3J, F-104, F-102, and 
X-15 have ample room for this slight increase. In the F4D, however, the 
area dimension of the suit is more critical because of compactness of the 
cockpit. In fitting pilots of this aircraft a compromise must be made in 
comfort but not in mobility by taking in the lacing adjustments to keep the 
fullness to a minimum. 

The general feeling is, and instructions to the pilot are, that this 
suit is an emergency get-down garment and that there will be no attempt 
to stay at altitude once the suit becomes inflated due to loss of cabin pres- 
surization above 35, 000 feet. But this does not mean that the pilot cannot, 
if he so chooses and the situation warrants, remain at altitude. As a matter 
of fact, in the flight testing of the F4H aircraft, because of loss of cabin 
pressurization from the test instrumentation lines running into the cockpit, 
many flights were made with the cockpit altitude well above 35, 000 feet and 
with the pilot in the suit in the pressurized condition. Both the Navy test 
pilots and the contract test pilots reported that there was no difficulty in fly- 
ing the aircraft even pressurized in the suit to 1-1/2 psi for periods of 30 to 
45 minutes. To the pilot, this means that in case of loss of cabin pressuriza- 
tion at altitude there is no urgency to nose the plane over and get down immed- 
iately. It means that he will have more time to take stock of the situation and 
more altitude for him to attempt relights. One rather important point was 
brought out by pilots of VF-142. During their training period part of their 
syllabus called for flights above 50, 000 feet. Up to this time, because of 
physiological limitation on altitude without pressure suits, this part of the 
syllabus could not be carried out. However, after they had been issued the 
suits, this portion of the syllabus was performed. The training officer and 
pilots report that the feeling of safety by wearing the suit and going to these 
altitudes allowed them to get a better feel of the aircraft and to develop full 
operational envelope of the aircraft. As a sidelight, it also put the mainte- 
nance officer on somewhat of a spot because it weeded out those aircraft that 
could not get above 55, 000 feet. 

Success and acceptance of the lightweight Mark IV Navy full pressure 
suit in no way indicate that the Bureau of Aeronautics or the Air Crew Equip- 
ment Laboratory are completely satisfied. They are still working on improve- 
ments to increase comfort and mobility, decrease weight, and supply compati- 
ble accessory equipment. Nevertheless, it is heartening to have Navy pilots drop 
into the training units and ask how they can get a Navy full pressure suit. 

In addition to its primary function of indoctrination in the full pressure 
suit, training units have been assigned to a number of testing and evaluational 



Medical News Letter, Vol. 34, No. 4 37 



studies in connection with the full pressure suits. The North Island unit, 
for instance, has testedthe effectiveness of an anti -fogging compound, under- 
water escape with the suit, explosive decompression studies with the suit, 
ground cooling units, and has conducted a series of habitability studies at 
altitude. These studies consisted of 2, 4, 8, 16, and 24-hour periods at 
80, 000 feet in the full pressure suit. During these periods, heart rate, 
respiratory rate, continuous ECG, and performance of psychological tests 
were observed; stress measurement studies were made; total oxygen corn- 
sumption was calculated; and the drying effect on the nasal, oral, and eye 
mucosa of long periods of exposure to an atmosphere of 100% oxygen was 
determined. These tests indicated that even with the 24-hour study at 80, 000 
there were no significant changes from normal in any of the measurements or 
or in general over-all physical well-being of the pilots. The unit at the Naval 
Air Station, Norfolk, extended their run to 72 hours and also found little or 
no significant physical changes. 

The North Island unit did a series of studies with Litton Industries 
both with their high altitude garment and the Navy's full pressure suit in 
their chamber which has altitude capabilities of 200 miles. These studies 
were particularly concerned with depression and inversion of the "T" waves 
of ECG tracings that were observed in some of the Litton subjects. A series 
of studies to determine effectiveness of the protection of the Navy full pres- 
sure suit afforded against ambient temperatures up to 250° F. were under- 
taken with Convair. Preliminary data indicate that the standard "unsilvered 1 
Navy full pressure suit would afford one hour protection if inlet vent air flow 
of 150 1pm and temperature of 5° F. were supplied. Using a silvered flight 
suit over the full pressure suit, 150 1pm vent air of 40° F. would afford pro- 
tection for one hour. 

In the spring of 1959, ComNavAir Lant authorized several squadrons 
and detachments to be indoctrinated and to use full pressure suits. These 
indoctrinations are now under way at the Naval Air Station, Norfolk, Va. 
However, inasmuch as the training air group in NavAirLant is located at Cecil 
Field, Fla. , it is planned to move this training unit to Cecil Field as soon as 
the facilities are completed there. (LCDR W. L. Goldenrath MSC USN, Naval 
Air Station, North Island, San Diego, Calif. ) 



Cardiac Arrest 

The following articles and professional films are recommended for 
study in arriving at a procedure for the management of cardiac arrest: 

"Treatment of Cardiac Arrest Occurring During Surgery, " J.H. Kay, 
R. Dever, R. A. Goertner, G. C. Kaiser, J. A. M. A. , 163 : 165-167, 
January 19, 1957) 



38 Medical News Letter, Vol, 34, No. 4 



"Cardiac Arrest and Resuscitation, " B. B. Milstein, Annals, Royal 
College of Surgeons, England, 19: 69-87, August 1956. 

"Cardiac Arrest at Work - Penknife Thoracotomy with Recovery, " 
CD. Brown, J. Knudson, G. F. Schroeder, J. A. M.A. , 163: 352-353, 
February 2, 195 7. 

"Cardiac Arrest, " H. Swan, J. C. Owen, silent, color, 32 minutes, 
procurable from: Henry Swan, M. D. , 4200 E. Ninth Ave. , Denver 7, Col. 

"Cardiac Arrest," E. H. Fell, L. Peterson, sound, color, 17 minutes, 
procurable from: Surgical Products Division, American Cyanamid Company, 
Danbury, Conn. 

"Resuscitation for Cardiac Arrest, ", C. S. Beck, sound, color, 20 minutes, 
procurable from: E. R. Squibb and Sons, 745 Fifth Ave. , New York 22, N. Y. 

(U.S. Air Force Medical Digest, April 1959) 

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Reserve Seminar in Aviation Medicin e 

The Fourth Annual Research Reserve Seminar in Aviation Medicine 
was held at the U.S. Naval School of Aviation Medicine, Pensacola, Fla. ,8-21 
March 1959. Forty-two Reservists attended, of whom 26 were Navy, 12 were 
Air Force, and 4 were Army. 

The Chief of Naval Air Training, RADM Robert Goldthwaite USN; 
RADM Rawson Bennett USN, Chief of Naval Research; CAPT Charles F, Gell 
MC USN, Special Assistant for Medical and Allied Sciences in the Office of 
Naval Research; and staff members of the School of Aviation Medicine ad- 
dressed the group. Visits to outlying fields to observe details of the training 
program and to Eglin Air Force Base were conducted. In addition, one day 
was spent on board the USS ANTIETAM to observe carrier qualification opera- 
tions. 

CDR Richard Trumbull MSC USNR served as Chairman; CDR H. A. Imus 
MSC USNR planned and directed the Seminar. The next Seminar in Aviation 
Medicine will be held at the School of Aviation Medicine in March 1961 since 
the Seminar alternates on an annual basis with the Seminar in Submarine and 
Diving Medicine. 



The Navy Doctor 

In no branch of Medicine, military or civilian, can one find such diver- 
sified activities as are found in the Medical Corps of the United States Navy. 
Every possible specialty of medicine is practiced by Navy doctors from 
Pediatrics and Obstetrics through the various medical and surgical specialties, 



Medical News Letter, Vol. 34, No. 4 39 



Aviation and Underwater Medicine, ABC Warfare, Tropical Medicine, and 
finally, Field Medicine. No other branch of military medicine encompasses 
so many aspects. 

The opportunities for a young doctor entering the U.S. Navy are lim- 
itless. A young doctor just out of medical college can intern at one of the top 
medical centers of the world . . . (among which) is the U.S. Naval Hospital, 
Bethesda, Md. If he chooses otherwise, he can intern at a civilian hospital of 
his choice and then following completion of internship enter the Navy as a 
Lieutenant, senior grade. At this point in his medical career, several avenues 
are opened to him. First, he . . . (may apply for) a Navy residency of his 
choice to continue in the field of his liking (provided he accepts a commission 
in the Medical Corps of the regular Navy). Second, he may enter into specialized 
military training in such fields as Aviation Medicine, Underwater Medicine, and 
Tropical Medicine, to mention only a few. Last, he may simply enter the service 
to fulfill his two years of obligatory duty under the Selective Service Law. 

Residency training in the Navy is as good or better than residencies found 
elsewhere. There are no limitations as to the type of residency training desired 
for if the Navy has not the facilities to train her men in certain fields, such as 
Neurosurgery, then this specialized training is arranged at civilian hospitals. 

There is never the fear of the low "resident's salary" so prominent in 
many of our leading teaching institutions, for the resident in the Navy is paid 
according to his rank. One of the most interesting points of this entire subject 
is the fact that recent statistics show that the number of board examinations taken 
and passed is markedly higher in the Navy, as in the other military branches, 
than in civilian residency programs. The exact reason for this is unknown, but 
it certainly is a point in favor of the military residency program. 

The specialized fields of military medicine are most interesting and 
most important in view of recent trends. Here, I speak of Aviation Medicine 
and Underwater Medicine, especially. The former is becoming more and more 
necessary as we near man's first venture into space. Of course, we think that 
this is far away, but mammoth strides are being taken daily and these first 
attempts are nearer than we realize. The question of man's underwater endur- 
ance for periods of days, weeks, and even months is being answered by Navy 
doctors as in the recent undersea adventures of our atomic submarines in the 
Arctic and Antarctic seas, Atomic, Biological and Chemical Warfare and all 
of their ugly and devastating possibilities are under constant investigation for 
protection of our nation, advancement of recent developments and yes, even 
retaliatory efforts if they need be resorted to. Tropical Medicine, a small but 
important facet of modern day medicine, is becoming more and more significant 
in light of steady migration of other peoples into our country, especially from 
Puerto Rico. 

Probably the most versatile group of Navy doctors are those who enter 
into the Navy for fulfillment of their Selective Service obligation. The oppor- 
tunities presented to this group are many and the duties that these men are to 



40 



Medical News Letter, Vol. 34, No. 4 



perform are quite diversified. After a short period of indoctrination, the 
doctor may be sent to any one of many duty stations. Included among these 
are sea duty aboard one of many types of ships from destroyers to aircraft 
carriers; duty with the Marines, where often Field Medicine is practiced; or 
duty in one of the many shore dispensaries throughout the world. With this 
short but interesting tour of duty the Navy doctor can "see the world. " In many- 
instances this short period of time is a period in which the young doctor will 
"find himself, " and thus be enabled to take giant strides in a particular direction 
in his medical career. A young doctor who may have started a residency and 
then had it interrupted by his obligated service . . . (may in some) instances 
be able to continue in (the practice of) his specialty during his short tour of duty. 
In summary, therefore, the career of a Navy doctor is one which is inter- 
esting, exciting, educational, and quite rewarding. And, more important, it 
gives him the opportunity to serve his country. (LT Patrick S. Pasquariello, Jr. , 
MC USNR, MCAS Cherry Point, N. C.) 

Note: This article originally appeared in the July 1959 issue of the St. Joseph's 
Hospital Staff News, St. Joseph's Hospital, Philadelphia, Pa. LT Pasquariello, 
presently attached to the 2nd Marine Aircraft Wing, Cherry Point, N. C. , was 
graduated from Jefferson Medical College in 1956 and subsequently interned 
at St. Joseph's Hospital. 



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